Triptans

Triptans: Quick Look

UseTreat moderate-to-severe migraines when they start (acute treatment); typically a first-line treatment.
EffectivenessLarge, high-quality clinical trials prove they work.
Migraine-specific?Yes
Prescription?Yes
Side effectsOccasional: Dizziness, chest discomfort, fatigue, sleepiness, and nausea.1 Triptans may not be suitable for some patients with risk factors for heart disease.2
Taken how?Triptans come in many forms: oral tablet, dissolving tablet, nasal spray, nasal powder, injection.
Drugs in this class
Brand Name(s)Generic Name
Alsuma, Imitrex, Onzetra, Zembrace, Treximet*sumatriptan
Amergenaratriptan
Axertalmotriptan
Frovafrovatriptan
Maxaltrizatriptan
Relpaxeletriptan
Zomigzolmitriptan
Brand Name(s)Generic Name
Alsuma, Imitrex, Onzetra, Zembrace, Treximet*sumatriptan
Amergenaratriptan
Axertalmotriptan
Frovafrovatriptan
Maxaltrizatriptan
Relpaxeletriptan
Zomigzolmitriptan

*combination of sumatriptan and naproxen

Triptans are a common first-line acute treatment for moderate-to-severe migraine. They work best when they are taken early in a migraine attack. For migraine with aura, triptans should be taken at the onset of pain, rather than the onset of aura.1 Triptans do not prevent migraine.

Triptans were developed specifically to treat migraine. They have been used since the 1990s.3 Currently, there are seven approved triptans.1 “Triptan” is a general term for the whole class of medications. The names of all the generic drugs in this class end in “triptan.”

Given the long history of use, triptans are well-studied. Health care providers are familiar with their use and side effects. Most triptans are available in generic form. Generics are less expensive than brand-name drugs.1 Nevertheless, triptans can be costly.

Triptans are available as tablets, capsules, quick dissolving tablets, injections, and nasal sprays. This variety gives you options. You and your health care provider can choose treatment based on your migraine pattern, symptoms, and budget.1

However, triptans are not for everyone. Some people with heart disease or cerebrovascular disease may not be able to take them. Triptans cannot be used together with certain medications. Triptans do not provide relief for every person or every headache. Frequent use can lead to medication overuse headache.

Poll

Have you taken Imitrex or generic sumatriptan for migraines?

How well do triptans work?

Triptans are one of the most effective acute treatments for migraine.4 In studies, triptans are more effective than ergotamine or DHE at 2 hours and 24 hours.5 Triptans also are more effective than non-prescription pain relievers at 2 hours.

One large “study of studies” (meta-analysis) showed that triptans relieve headache within 2 hours for 43 percent to 76 percent of patients.5 Between 18 percent and 50 percent of patients are free of pain 2 hours after taking a standard-dose triptan.5 At 24 hours, 29 percent to 50 percent have sustained headache relief, and 18 percent to 33 percent are free of headache pain.5

These ranges are wide and are based on groups of study participants. These results do not tell you whether a medication will work for you personally.

What are the possible side effects of triptans?

Triptans bind to—or connect with—serotonin receptors. Specifically, triptans bind to subtypes of the receptor called 5-HT1B and 5-HT1D. Binding of the triptan to the 5-HT1B and 5-HT1D receptors in the brain reduces swelling in the blood vessels, which may be one reason they stop the migraine. (They may also work by disrupting pain signals from the nerves.)

Triptans also affect 5-HT1B and 5-HT1D receptors in other parts of the body. It may not be safe for people with heart disease or cerebrovascular disease to use a drug that constricts the blood vessels. Your health care provider will evaluate whether you are at risk for vascular disease.

Common side effects of triptans include dizziness, chest discomfort, fatigue and sleepiness, muscle weakness, and nausea. Triptans can cause changes in sensation such as warmth, burning, cold, tingling, or numbness. Some triptans cause dry mouth or indigestion.6

These are not all the possible side effects of triptans. Patients should talk to their doctor about what to expect with treatment with triptans.

What are the brand names of triptans?

Triptans, like many drugs are available as and are referred to by both generic and brand names.

Brands (generics):2,3,4

  • Alsuma (sumatriptan) is an injection
  • Amerge (naratriptan) is a tablet
  • Axert (almotriptan) is a tablet
  • Frova (frovatriptan) is a tablet
  • Imitrex (sumatriptan) is a tablet
  • Imitrex nasal (sumatriptan) is a nasal spray
  • Imitrex Statdose (sumatriptan) is an injection
  • Maxalt (rizatriptan) is a tablet
  • Maxalt MLT (rizatriptan) is a dissolving tablet
  • Onzetra Xsail (sumatriptan nasal powder)
  • Relpax (eletriptan) - RECALLED in 2019
  • Sumavel DosePro (sumatriptan) is a needleless injection - NO LONGER MADE as this has been discontinued
  • Treximet (sumatriptan and naproxen sodium)
  • Zembrace SymTouch (sumatriptan succinate)
  • Zomig (zolmitriptan) is a tablet
  • Zomig nasal (zolmitriptan) is a nasal spray
  • Zomig ZMT (zolmitriptan) is a dissolving tablet

What are the differences between the triptans?

Most triptans deliver roughly the same pain relief.5 Eletriptan and rizatriptan may be slightly more effective than the others.5 Eletriptan, rizatriptan, almotriptan, sumatriptan and zolmitriptan work faster and work for more people, but the risk of recurrence is higher.7 Naratriptan and frovatriptan may be slightly less effective,5 but they usually cause fewer side effects.7

Frovatriptan is effective for short-term prevention of menstrual migraine.8 This use is “off-label” (not FDA approved).

People who do not respond to one triptan may respond to a different one.9 If your current triptan is not working for you, talk with your health care provider about trying a different one.

You should begin no medication or supplement without first checking with your health care provider and should let them know of any other prescriptions, OTCs, and herbals you are taking to ensure there are no interactions.

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Written by: Sarah O'Brien | Last reviewed: July 2020